American College of Rheumatology Guidance for the Management ofRheumatic Disease in Adult Patients during the COVID-19 Pandemic:

Version 3 (Part 4)

We will resume our discussion on the treatment guidelines for rheumatic disease (RD) at the time of Coronavirus disease (Covid) as presented by the American College of Rheumatology (ACR).

The use of nonsteroidal drugs (NSAID) is something that is worth discussing as there have been speculations raised early in the pandemic as regards the NSAID use and possible links with worse Covid result and these concerns have yet to be verified.

The ACR task force endorses the use of the NSAID and prescription of these drugs as indicated for newly diagnosed rheumatic disease.

However, NSAID use should be halted in the event of severe Covid presentation like kidney, cardiac, or gastrointestinal injury, which provide a poor prognosis.

The ACR task force showed low consensus to whether or not NSAIDs should be discontinued in situations of less severe Covid, where the use of such drugs might provide therapeutic antipyretic and/or antiinflammatory benefit.

Some experts have pushed for the use of acetaminophen or paracetamol as an alternative to NSAIDs as appropriate caution should be observed since there has been evidence of liver injury accompanying Covid in a number of cases.

Let’s continue our discussion next week by discussing the use of glucocorticosteroids.